NPI | 1154803054 |
---|---|
Former Name | AMBER ELIZABETH WITWICKI |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CO 4458) |
Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CO 4458) |
Enumeration Date | 2018-09-06 |
Last Update Date | 2024-02-20 |